Clinical Efficacy of the Transradial Approach in Percutaneous Intervention for a Malfunctioning Arteriovenous Fistula

Purpose@#To evaluate the effectiveness of the transradial artery approach (TRA) for treating malfunctioning arteriovenous fistulas (AVFs) in patients on hemodialysis. @*Materials and Methods@#A retrospective analysis was conducted in this single-center study of TRA endovascular procedures in 73 patients (43 male and 30 female; mean age of 67.4 years (range, 42–92 years) with malfunctioning AVFs, between January 2008 and April 2019. Patients’ baseline and lesion characteristics, technical and clinical success, and complications were evaluated, and functional patency was analyzed using the Kaplan-Meier method. @*Results@#Radial artery approaches were successful in all patients. Angioplasty performed using the TRA achieved technical and clinical success rates of 98.6%(72/73) and 91.7%(67/73), respectively. The median primary patency time was 18.8 ± 15.9 months. The primary functional patency rates at 3, 6, and 12 months were 82.1%, 68.6%, and 63.9%, respectively. There were no major complications or adverse events, such as hand ischemia, related to the radial artery approach. @*Conclusion@#In selected cases, the TRA can be used complementary to the transvenous approach to treat malfunctioning AVFs.

Percutaneous Transgastric Stent Placement for Malignant Gastroduodenal Obstruction

Purpose@#To evaluate the technical feasibility and clinical efficacy of percutaneous transgastric stent placement after the failure of treatment attempt with the transoral approach in malignant gastroduodenal obstruction patients. @*Materials and Methods@#From October 2008 to April 2016, nine patients (M:F = 4:5; mean age = 66 years) with malignant gastroduodenal obstruction underwent stent placement via a gastrostomy tract, which was attributed to the failure of the transoral approach. The primary etiologies of the obstruction were pancreatic (n = 5), gastric (n = 2), and metastatic (n = 2) cancers. Through percutaneous gastrostomy, dual stents (inner bare metal and outer polytetrafluoroethylene-covered) were deployed at the obstruction site. The technical and clinical success rates, as well as complications were evaluated during the follow-up period. @*Results@#Stents were successfully inserted in eight patients (88%). We failed to insert stent in one patient due to the presence of a tight obstruction. After stent placement, symptoms improved in seven patients. Gastrostomy tube was removed 9 to 20 days (mean = 12 days) after the stent insertion. During the mean follow-up of 136 days (range, 3–387 days), one patient developed a recurrent symptom due to tumor overgrowth. However, there were no other major complications associated with the procedure. @*Conclusion@#Percutaneous transgastric stent placement appeared to be technically feasible and clinically effective in patients who underwent a failed transoral approach.

Usefulness of 18 F-FDG PET/CT and Multiphase CT in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular CarcinomaCholangiocarcinoma

Purpose@#The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). @*Materials and Methods@#From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). @*Results@#cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. @*Conclusion@#The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Usefulness of 18 F-FDG PET/CT and Multiphase CT in the Differential Diagnosis of Hepatocellular Carcinoma and Combined Hepatocellular CarcinomaCholangiocarcinoma

Purpose@#The purpose of this study was to evaluate the usefulness of multiphasic CT and 18 F-fluorodeoxyglucose (FDG) PET/CT for the differentiation of combined hepatocellular carcinomacholangiocarcinoma (cHCC-CCA) from hepatocellular carcinoma (HCC). @*Materials and Methods@#From January 2007 to April 2016, 93 patients with pathologically confirmed HCC (n = 84) or cHCC-CCA (n = 9) underwent CT and PET/CT imaging. Contrast enhancement patterns were divided into three types based on the attenuation of the surrounding liver parenchyma: type I (early arterial enhancement with delayed washout), type II (early arterial enhancement without delayed washout), and type III (early hypovascular, infiltrative appearance, or peripheral rim enhancement). @*Results@#cHCC-CCAs (89%) had a higher PET/CT positive rate than did HCCs (61%), but the PET/ CT positive rate did not differ significantly (p = 0.095). Among the 19 cases of the type II enhancement pattern, 3 (21%) of 14 HCCs and 4 (80%) of 5 cHCC-CCAs were PET/CT positive. cHCC-CCAs had a significantly higher PET/CT positive rate (p = 0.020) in the type II enhancement pattern. @*Conclusion@#The PET/CT positive rate of cHCC-CCA was significantly higher than that of HCC in lesions with a type II enhancement pattern. The 18 F-FDG PET/CT can be useful for the differentiation of cHCCCCA from HCC in lesions with a type II enhancement pattern on multiphasic CT.

Popliteal Artery Agenesis Detected by CT Angiography

Variations in the popliteal artery and its tibial branches are common and have assumed greater importance with the technological advances that have made below-knee interventional revascularization feasible. The authors report a rare anatomic variant of popliteal artery agenesis, describing the CT angiographic findings with emphasis on the differential point from the occlusive disease and reviewing the embryologic development of the lower extremity vasculature.

A Case of Improved Leukocytoclastic Vasculitis after Successful Treatment of Hepatocellular Carcinoma and Membranous Obstruction of Inferior Vena Cava

Vasculitis is a heterogeneous group of diseases that destroy blood vessel walls by inflammation. Approximately half of vasculitis cases are idiopathic, but sometimes associated with genetic factors, medicines, chronic infection, autoimmune diseases, and malignancies. Although the mechanism remains unclear, vasculitis secondary to malignancy, also known as paraneoplastic vasculitis, has been reported. It is generally associated with hematologic malignancies rather than solid malignancies and commonly presents as leukocytoclastic vasculitis or polyarteritis nodosa. We experienced a case of leukocytoclastic vasculitis in a patient with hepatocellular carcinoma and membranous obstruction of the inferior vena cava. Here, we report this case with a brief review of literature.

Acute Renal Failure in a Renal Allograft Recipient Caused by a Post-Biopsy Renal Arteriovenous Fistula with Transplant Renal Artery Stenosis / 대한이식학회지

Renal biopsy is an essential diagnostic tool for detecting acute and chronic kidney rejection as well as recurrent and de novo nephropathies in renal allograft recipients. However, a well-known complication of percutaneous renal biopsy is arteriovenous fistula (AVF). Most post-biopsy AVFs are asymptomatic and regress spontaneously but some AVFs result in hypertension, hematuria, and renal insufficiency. Whether post-biopsy AVF superimposed on transplant renal artery stenosis (TRAS) also regresses spontaneously is unknown. We present a case of acute renal insufficiency in a 51-year-old female renal allograft recipient with post-biopsy AVF and TRAS. Percutaneous angioplasty with stent implantation was performed for the TRAS and transcatheter arterial coil embolization therapy applied for AVF. The patient's renal function returned to baseline levels and is currently being followed up for 6 months.

A Case of Idiopathic Acute Renal Infarction / 대한내과학회지

Renal thromboembolism almost always occurs in the setting of cardiac disease. Acute renal infarction may occur rarely in middle-aged patients without apparent risk factors for cardiac thromboembolism. We report a 40-year-old man who developed bilateral renal infarction and had no cardiovascular risk factors, except smoking. In middle-aged healthy patients with renal colic without lithiasis, the diagnosis of idiopathic renal infarction should be considered, especially if lactate dehydrogenase is elevated.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

Successful Chemotherapy Following Autologous Stem Cell Transplantation in Multiple Myeloma and Multi-organ Dysfunction with Infiltration of Eosinophils: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Eosinophils are derived from hematopoietic stem cells. Peripheral blood eosinophilia is defined as an absolute eosinophil count of > or =0.5x10(9)/L. Eosinophilia is classified into primary or clonal eosinophilia, secondary eosinophilia, and idiopathic categories including idiopathic hypereosinophilic syndrome. Both hematopoietic and solid neoplasms may be associated with peripheral blood eosinophilia, but multiple myeloma is rarely associated with eosinophilia. We now report the case of a 31-year-old man with multiple myeloma associated with marked eosinophilia who developed multiple organ dysfunction with infiltration of eosinophils. He recovered after treatment with chemotherapy followed by autologous stem cell transplantation.

Transcatheter Arterial Embolization Using Ethanol in a Dialysis Patient for Contracting Enlarged Polycystic Kidneys

The mass effect of nephromegaly in patients with autosomal dominant polycystic kidney disease may cause pain and symptoms by compressing the alimentary tract, lungs, and heart. Conventional therapies exist to contract enlarged polycystic kidneys including surgical and interventional procedures. A surgical nephrectomy is often difficult to perform in dialysis patients due to the associated risks related to surgery. In contrast, renal transcatheter arterial embolization (TAE) with metallic coils, which is a less invasive interventional procedure, can also be utilized to contract enlarged kidneys in dialysis patients as an effective treatment. However, metallic coils present the possibility of recanalization and cost issues. Thus, we used ethanol instead of coils in renal TAE to resolve these issues. We report a dialysis patient with enlarged polycystic kidneys and poor oral intake due to abdominal distention that was successfully treated by TAE with absolute ethanol.

Self-Expandable Polytetrafluoroethylene (PTFE)-covered Nitinol Stent for the Palliative Treatment of Malignant Biliary Obstruction

PURPOSE: We wanted to determine the technical and clinical efficacy of placing a self-expandable PTFE-covered nitinol stent for the management of inoperable malignant biliary obstruction. MATERIALS AND METHODS: Thirty six patients with inoperable malignant biliary obstructions were treated by placement of self-expandable PTFE-covered nitinol stents (S & G Biotech Corporation, Seongnam, Korea). Clinical evaluation was done with assessment of the serum bilirubin and alkaline phosphatase levels, which were measured before and after stent placement within 1 week, at 1 month and at 3 months. The patient survival rate and stent patency rate were calculated with performing Kaplan-Meier survival analysis. RESULTS: Successful stent placement was achieved in all the patients without procedure-related complication. Pancreatitis as an early complication occurred in two cases. The serum bilirubin and alkaline phosphatase levels were significantly decreased after the procedure. During the follow-up, recurrent obstructive jaundice occurred in six cases; stent migration occurred in four cases and tumor overgrowth occurred in two cases. The survival rates were 97%, 80%, 67% and 59% at 1, 3, 6 and 9 months, respectively. The stent patency rates were 96%, 92%, 86% and 86% at 1, 3, 6 and 9 months, respectively. CONCLUSION: Self-expandable PTFE-covered nitinol stent placement seems to be technically feasible and effective for the palliative treatment of malignant biliary obstruction.

Covered Self-Expandable Metallic Stent Placement for a Post-operative Malignant Anastomotic Stricture Secondary to Recurrent Gastric Cancer

PURPOSE: To evaluate the technical feasibility and clinical effectiveness of stent placement for the treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer. MATERIALS AND METHODS: Under fluoroscopic guidance, one or two covered stents were placed in 20 consecutive patients (age range, 44-75 years) with an anastomotic stricture due to a recurrent gastric malignancy. Before stent placement, all patients had severe nausea and recurrent vomiting after ingestion. RESULTS: Stent placement was technically successful for all patients, and no procedural complications occurred. After stent placement, 18 of 20 (90.0%) patients were able to ingest at least a liquid diet and had a markedly decreased incidence of vomiting. During the follow-up of 2-116 weeks (mean, 25.5 weeks), stent migration occurred in two patients (10.0%) on one day after the procedure. All patients with stent migration were treated successfully by means of placing a second stent. Three patients showed a recurrence of the stricture due to tumor overgrowth; two of the patients were treated with coaxial placement of a second stent. Another patient refused additional management. CONCLUSION: Covered self-expandable metallic stent placement seems to be technically feasible and effective for palliative treatment of a post-operative malignant anastomotic stricture secondary to recurrent gastric cancer.

Treatment of Malignant Gastroduodenal Obstruction with Using a Newly Designed Complex Expandable Nitinol Stent: Initial Experiences

PURPOSE: We wanted to evaluate the usefulness of a new type of a complex expandable nitinol stent that was designed to reduce the stent's propensity to migration during the treatment of malignant gastroduodenal obstructions. MATERIALS AND METHODS: Two types of expandable nitinol stent were constructed by weaving a single thread of 0.2 mm nitinol wire in a tubular configuration: an uncovered stent 18mm in diameter and a covered stent 16mm in diameter. Both ends of the covered stent were fabricated by coaxially inserting the covered stent into the tubular uncovered stent and then attaching the two stents together with using nylon monofilament. Under fluoroscopic guidance, the stent was placed in 29 consecutive patients (20 men and 9 women, mean age: 65 years) who were suffering with malignant gastric outlet obstruction (n=20), duodenal obstruction (n=6) or combined obstruction (n=3). Clinical improvement was assessed by comparing the food intake capacity before and after the procedure. The complications were investigated during the follow up period. RESULTS: Stent placement was successful in all the patients. After stent placement, the symptoms improved in all but one patient. During the follow up, stent migration occurred in one patient (3%) at 34 days after the procedure. Despite the stent migration, the patient was able to resume a soft diet. Six patients developed recurrent symptoms of obstruction with tumor overgrowth at a mean of 145 days after the procedure; all the patients underwent coaxial placement of an additional stent with good results. One patient showed recurrence of obstruction due to tumor in-growth, and this was treated by placement of a second stent. Two patients with stent placement in the duodenum suffered from jaundice 26 days and 65 days, respectively, after their procedures. CONCLUSION: Placement of the newly designed complex expandable nitinol stent seems to be effective for the palliative treatment of malignant gastroduodenal obstructions. The new stent also seems to help overcome the disadvantage of the increased migration observed for the covered stent.

Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

PURPOSE: To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. MATERIALS AND METHODS: From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous transabdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018"or 0.035" guidewire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. RESULTS: Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted. The catheter did not interfere with defecation and there was no incidence of catheter expulsion by defecation. CONCLUSION: Transrectal drainage of deep pelvic abscesses using ultrasound and fluoroscopic guidance is a safe, feasible procedure that is well tolerated by patients and is relatively easy to perform.

Percutaneous Radiofrequency Ablation of Inoperable Primary Lung Cancer

PURPOSE: To present the initial experience of percutaneous radiofrequency ablation (RFA) of inoperable primary lung cancer, and to assess the technical feasibility and potential complications. MATERIALS AND METHODS: Twenty patients with inoperable lung cancer underwent percutaneous RFA. Nineteen of 20 patients had stage III or IV non-small cell lung cancer, and the remaining one had stage I lung cancer with pulmonary dysfunction. The mean tumor size was 4.6+/-0.4 cm (range, 1.8-8.4 cm). RFA was performed with a single (n=18) or cluster (n=2) cool-tip RF electrode and a generator under CT guidance using local anesthesia and conscious sedation. Twenty tumors were treated in 28 sessions. Patients were assessed by contrast-enhanced CT in all cases at 1 week, 1 month, and 3 months. Eleven patients received chemotherapy (n=10) or radiotherapy (n=1) after RFA. RESULTS: RFA was technically successful and well tolerated in all patients. Complete necrosis was attained in 7 lesions (35%), near complete (90-99%) necrosis in 10 lesions (50%), and partial (50-89%) necrosis in 3 lesions (15%). During the mean follow up of 202 days (21 to 481 days), tumor size was decreased in 13 patients, unchanged in 3, and increased in 4. In the latter four, additional RFA was performed. One patient underwent surgery three months after RFA and the histopathologic findings showed a large cavity with thin fibrotic wall suggestive of complete necrosis. During or after the procedure, pneumothorax (n=10), moderate pain (n=4), blood tinged sputum (n=2), and pneumonia (n=2) were developed. Chest tube drainage was required in only 1 patient due to severe pneumothorax. Other patients were managed conservatively. Seven patients died at 61 to 398 days (mean, 230 days) after RFA. The remaining 13 patients were alive 21 to 481 days (mean, 187 days) after RFA. CONCLUSION: RFA appears to be a technically feasible and relatively safe procedure for the cytoreductive treatment of inoperable, non-small cell lung cancer and warrants further investigation as a complementary treatment to chemotherapy or radiation therapy.

Primary Liposarcoma of the Mediastinum: Computed Tomographic (CT) Findings

PURPOSE: To describe the CT findings of primary liposarcoma of the mediastinum, and to correlate these with the pathologic findings. MATERIALS AND METHODS: We retrospectively reviewed the medical records, chest radiographs and CT scans of four male patients with histopathologically proven primary liposarcoma of the mediastinum treated between September 1996 and April 2002. The CT scans were analyzed by two radiologists, and final decisions were reached by consensus. They were analysed in terms of tumor size and location, enhancement pattern, the pattern of the fat component, calcification, mass effect, pleural effusion, lymph node enlargement, pericardial effusion, tumor extension to the costophrenic junction, and adjacent organ invasion. RESULTS: All patients presented with dyspnea and chest pain. Pathologic subtypes, which were well-differentiated and pleomorphic, were myxoid (n=2) and mixed (n=2). The transverse diameter of the mass ranged from 10.5 to 21 cm. All tumors were located in the anterior mediastinum, and all had lobulated margins. Soft-tissue attenuation predominance (n=2) occurred in the myxoid type, and roughly equal amounts of fat and soft-tissue attenuation (n=2) were present in the mixed type. A small area at calcification was seen in the mixed type (n=1). Mass effect on mediastinal structures was demonstrated in all patients. In three patients, the tumor draped around and conformed to the shape of the costophrenic junction. Chest wall invasion occurred in one patient. CONCLUSION: Findings of an anterior mediastinal location, fat attenuation, mass effect, the invasion of adjacent organs, and a lobulated margin strongly suggested mediastinal liposarcoma. CT attenuation of the lesions correlated closely with the degree of histologic differentiation.

A New Liquid Embolic Agent(Embol) for Transcatheter Renal Artery Embolization: An Experimental Study in Rabbit

PURPOSE: To evaluate the effectiveness and safety of a new liquid embolic agent in renal arterial embolization in the rabbit, and its clinical applicability. MATERIALS AND METHODS: A new embolic agent, Embol, was obtained by partial hydrolysis of polyvinyl acetate and dissolved in a mixture of 45% ethanol and 55% non-ionic contrast medium. Its radioopacity was therefore good. An average of 0.8 cc(0.5-0.9 cc) of Embol was used to embolize the renal artery of one kidney in 15 rabbits. The immediate effect of this was examined angiographically 5 minutes after the procedure. To permit histologic examination, five rabbits in each group were sacrificed 3 days (I), 2 weeks (II), and 4 weeks (III) after embolization: prior to embolization and prior to sacrifice, one rabbit in each group underwent renal scanning, and prior to sacrifice all underwent follow-up angiography. In three rabbits, blood urea nitrogen (BUN), creatinine, sodium(Na), and potassium(K) levels were measured before and 1, 3, 5, 7 and 14 days after embolization. RESULTS: Embol was easy to use and its radiopacity was good. Five minutes after embolization, angiography showed that total occlusion of the main renal or interlobar artery had been achieved in all rabbits. Serum BUN, creatinine, Na and K levels were within normal limits. Follow-up angiogram obtained in each group showed persistent occlusion of the renal artery in all but one rabbit in group I and one in group III. Renal scans revealed no evidence of radionuclide uptake in embolized kidneys, which were slightly enlarged in group I but became gradually smaller in groups II and III. In all animals, histologic examination showed diffuse coagulation necrosis of the embolized kidneys and in group III the cortex of these was extensively calcified. In group I the renal artery showed an apparently fresh occluding thrombosis, and in groups II and III a completely organized thrombosis was present. In group III this was calcified. CONCLUSION: Because of its good radioopacity, Embol is easy to controa, and is effective for renal artery embolization. As a permanent embolic agent, it appears suitable for clinical applications.

Stent Insertion in Patients with Malignant Biliary Obstruction: Problems of the Hanaro Stent

PURPOSE: To investigate the problems of the Hanaro stent (Solco Intermed, Seoul, Korea) when used in the palliative treatment of patients with inoperable malignant biliary obstruction. MATERIALS AND METHODS: Between January 2000 and May 2001, the treatment of 46 patients with malignant biliary obstruction involved percutaneous placement of the Hanaro stent. Five patients encountered problems during removal of the stent's introduction system. The causes of obstruction were pancreatic carcinoma (n=2), cholangiocarcinoma (n=2), and gastric carcinoma with biliary invasion (n=1). In one patient, percutaneous transhepatic cholangiography and stent insertion were performed as a one-step procedure, while the others underwent conventional percutaneous transhepatic biliary drainage for at least two days prior to stent insertion. A self-expandable Hanaro stent, 8-10 mm in deameter and 50-100 mm in lengh, and made from a strand of nitinol wire, was used in all cases. RESULTS: Among the five patients who encountered problems, breakage of the olive tip occourred in three, upward displacement of the stent in two, and improper expansion of the distal portion of the stent, unrelated with the obstruction site, in one. The broken olive tip was pushed to the duodenum in two cases and to the peripheral intrahepatic duct in one. Where the stent migrated during withdrawal of its introduction system, an additional stent was inserted. In one case, the migrated stent was positioned near the liver capsule and the drainage catheter could not be removed. CONCLUSION: Although the number of patients in this study was limited, some difficulties were encountered in withdrawing the stent's introduction system. To prevent the occurrence of this unusual complication, the stent should be appropriately expansile, and shape in the olive tip shoud be considered.

The Effect of Percutaneous Transluminal Angioplasty on Hemodialysis Shunt Insufficiency / 대한신장학회잡지

PURPOSE: The purpose of this study was to evaluate the effect of percutaneous transluminal angioplasty(PTA) and to determine patency rates and the factors affecting the long-term patency rates in the management of insufficient arteriovenous fistulae. METHODS: Sixty-one cases of insufficient dialysis shunts in 53 patients underwent venography of the fistula. These patients' indications of venographys were reviewed. Forty-six cases of insufficient dialysis shunts in 38 patients were treated by PTA. These patients' clinical characteristics and patency rates were evaluated. According to the patient's age, history of diabetes mellitus, duration of renal failure, type and age of the arteriovenous fistula, the site of AVF and length of the stenosis, and to the degree of residual stenosis, patency rates were compared within each subgroup using the Kaplan-Meier log- rank test. To estimate reasons for the incidence of vascular access failure, Cox regression model was used. Venographic findings of failed PTAs and PTA related complications were evaluated RESULTS: The success rate was 80.7%. In cases in which initial success was obtained, postintervention primary patency rate at 6, 12 and 24 months were 68%, 38% and 5% respectively. With repeatitive PTAs, postintervention assisted primary patency rate at 6, 12 and 24 months were 69%, 40% and 10% respectively. The effect of the above mentioned factors(age, DM, duration of CRF etc.) on long-term patency was not statistically significant(p > 0.05). Among 11 cases of failed PTA, there were 6 cases of total obstruction due to massive thrombosis and 5 cases of extensive vascular stenosis(>5 cm of length, >4 sites of stenosis and >75% of stenosis in all cases). There were no PTA related complications. CONCLUSION: PTA is considered to be an effective and safe treatment modality for shunt stenosis. No factors affected long-term patency rates in our study.